Introductory Concepts

Question 1

Bronchi anatomy mnemonic

Answer 1

A PALM Seed Makes Another Little Palm (right lung) ASIA ALPS (left lung)

Question 2

Interlobar fissures

Answer 2

minor/horizontal fissure: RUL and RML

major/oblique fissure: RUL/RML and LUL and LUL

Question 3

azygous fissure

Answer 3

accessor yfissure in RUL

Question 4

direct signs of atelectasis

Answer 4

vascular crowding, displacement of fissures

Question 5

indirect signs of atelectasis

Answer 5

elevation of diaphragm, rib crowding on side of volume loss, mediastinal shift, overinflation of adjacent/contralateral lobes, hilar displacement

Question 6

are air bronchograms seen in atelectasis?

Answer 6

not when atelectasis is due to central bronchial obstruction

air bronchograms seen with subsegmental atelectasis

Question 7

types of atelectasis

Answer 7

obstructive, relaxation, adhesive, cicatrical

Question 8

obstructive atelectasis

Answer 8

bronchial obstruction > lobar atelectasis, volume loss; subsegmental atelectasis due to mucus obstruction of small airways

occurs more often with supplemental oxygen or in aspirated foreign bodies (ball-valve effect)

Question 9

relaxation/passive atelectasis

Answer 9

relaxation of lung adjacent to intrathoracic lesion (pleural effusion, pneumothorax, pulmonary mass)

Question 10

adhesive atelectasis

Answer 10

surfactant deficiency; ARDS or neonatal RDS

Question 11

cicatrical atelectasis

Answer 11

volume loss from architectural distortion of lung parenchyma by fibrosis

Question 12

lobar atelectasis

Answer 12

central bronchial obstruction (mucus plug/mass)

acutely: mucus plugging
outpatient: rule out mass

Question 13

LUL atelectasis signs

Answer 13

luftsichel sign; crescent of air lateral to aortic arch

Question 14

RUL atelectasis sign

Answer 14

reverse S sign of Golden, also raises concern for underlying malignancy

juxtaphrenic peak sign (traction from inferior accessory fissure/inferior pulmonary ligament)

Question 15

LLL atelectasis sign

Answer 15

flat waist sign

Question 16

RLL atelectasis sign

Answer 16

collapsed lower lobe; wedge shaped retrocardiac opacity

Question 17

RML atelectasis

Answer 17

silhouetting of right heart border; wedge shaped opacity anteriorly

Question 18

round atelectasis

Answer 18

associated with adjacent pleural abnormality (effusion, thickening, plaque, pleural neoplasm); commonly posterior lower lobes

Question 19

requirements for diagnosing round atelectasis

Answer 19

1. abnormal adjacent pleura
2. peripheral opacity in contact with pleura
3. round/elliptical opacity
4. volume loss present in affected lobe
5. pulmonary vessels must curve (comet tail sign)